1. Technical Field
This invention relates to arteriograms and arterial catheterizations for therapeutic procedures and, in particular, relates to a surgical instrument embodied as an arterial needle or as a cannula for specific use in such procedure for insertion into the lumen of a blood vessel.
2. Background Art
The prior art, U.S. Pat. No. 2,566,499 relates to an expansile surgical needle; U.S. Pat. No. 2,842,133 relates to a surgical or medical vein dilating device; U.S. Pat. No. 3,330,278 relates to a hypodermic needle for a cannula placement unit; U.S. Pat. No. 3,568,660 relates to a pacemaker catheter; U.S. Pat. No. 3,610,239 relates to a detachable hollow guide needle; U.S. Pat. No. 3,677,244 relates to a removable catheter needle; U.S. Pat. No. 4,147,165 relates to a separable needle for inserting a catheter into the blood stream.
The immediate operating site is defined as being above the plane of the operating table with the patient lying on his back on such operating table. Physical access to the immediate operating site is limited to one lateral side of the operating table because the other lateral side of the operating table is spatially occupied by x-ray equipment and other monitoring equipment disposed above the plane of the operating table. Since access to the patient is limited to one lateral side of the operating table, only two persons can physically occupy and function on that "free" lateral side of the operating table. These two persons are the surgeon and his assistant. Since the surgeon wants to and must maintain by himself full and complete physical control at all times of the surgical procedure being performed, the surgeon does not want his assistant physically involved in the surgical procedure being performed other than in handing the surgeon instruments, etc. or otherwise in performing such tasks as so directed by the surgeon. Moreover, the immediate operating site is cluttered with tubing, wiring, and the like, associated with such equipment. The old saying of too many cooks spoil the broth applies. More than two persons participating at the immediate operating site results in their physical interference with one another and with the surgical procedure being performed, as well as rendering the maintenance of sterility difficult if not impossible. This explanation of the prior-art problems with respect to the immediate operating site points up the need for the surgical instrument of this invention embodied as a surgical needle or embodied as a cannula which the surgeon himself can insert into the lumen of the blood vessel that has been penetrated and which surgical instrument the surgeon by himself can thereafter withdraw and remove with one hand from such blood vessel, remove with one hand from the patient's body, and thereupon with one twisting movement of his one hand break apart and discard--while with his other free hand maintaining compression on the puncture site to prevent bleeding and hematoma formation.
Arteriograms and arterial catherizations for therapeutic procedures include the following sequence of maneuvers: (1) penetrating the blood vessel with a surgical instrument such as an arterial needle or a cannula employing a stylet; (2) disposing such surgical needle or cannula into the arterial lumen; (3) threading a long guide wire through the needle or cannula into the arterial lumen; (4) removing the arterial needle or cannula from the artery and patient's body, and sliding the arterial needle or cannula out of the proximal end of the guide wire, leaving the guide wire in the arterial lumen; (5) introducing a blood vessel dilator proximally along the guide wire and distally into the arterial lumen to enlarge the puncture hole for subsequent catheterization; (6) removal of the dilator from the artery and sliding it proximally along and out of the guide wire; (7) introducing the catheter over the guide wire proximally and then sliding same distally over such guide wire and into the arterial lumen; (8) removing the guide wire proximally and leaving the emplaced catheter for examination or therapeutic purposes.
In the arterial system, blood flows under high pressure. Therefore, once the arterial wall is punctured, continuous compression on the punctured site is critical to prevent bleeding and hematoma formation. Such continuous compression is accomplished by the surgeon's application of finger pressure, thereby leaving the surgeon with only his other hand to manipulate the surgical instrument of this invention embodied as an arterial needle or as a cannula to withdraw such surgical instrument from the patient's artery, to remove such surgical instrument from the patient's body, and to thereupon break same apart with an applied twisting motion of that other hand and to discard same. Therefore, such a surgical instrument that can be broken apart by applied twisting motion of one hand is essential.
When a guide wire is in the arterial lumen, blood clots will start forming around such emplaced guide wire. These clots can result in blockage of the artery and possibly can lead to loss of an organ or extremity, or necessitate a second surgical procedure for the removal of such clot. Hence, the faster the emplaced is removed, the lesser will be the chance of such described complications. Since the surgical instrument of this invention can be easily and quickly broken apart by twisting motion applied by one hand, a great deal of time is saved because the arterial needle or cannula does not have to be slid along the entire length of the guide wire to the proximal end of such guide wire to effect the removal of such arterial needle or cannula, but can be simply removed from the blood vessel and broken apart. Additional time is saved for the reason that the guide wire does not have to be sterilized after removing and breaking apart such arterial needle or cannula in comparison to the prior-art requirement for such sterilization of the guide wire. In the prior art, with the removal of such surgical needle from the proximal end of the guide wire, the guide wire becomes bacterially contaminated with blood. Accordingly, such guide wire must be sterilized before the blood vessel dilator or the catheter is introduced proximally over such guide wire and then distally into the arterial lumen. Such ability of the surgeon to break away the arterial needle or cannula with one hand permits such surgeon's assistant to be employed in threading the catheter, in regulating the infusion of material, in preparing the equipment for sequential study or treatment, and in maintaining the sterile operating field.
The integral locking mechanism incorporated in this invention's surgical instrument is important in maintaining needle or cannula integrity without leakage of blood for the reason that arteries are deep structures with blood flow under high pressure, and tissue and artery penetration must be accomplished without loss of such integrity.
Accordingly, the object of the invention is to contribute to the solution of the discussed problems of the prior art by providing the surgical instrument of this invention embodied as an arterial needle or as a cannula which the surgeon with one hand can controllably insert into the arterial lumen, can thereafter controllably withdraw with the same hand therefrom and thereupon with the same hand break apart and discard such surgical instrument.